Nuray Voyvoda

Changes in renal Doppler ultrasonographic parameters in patients managed with rigid ureteroscopy.

Background There has been no study evaluating the intrarenal hemodynamic changes after ureteroscopy in the published literature. Purpose To determine preoperative and postoperative intrarenal vascular parameters such as resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), measure changes on these values (ΔRI, ΔPI, ΔPSV, ΔEDV) after ureteroscopy (URS) and compare the outcomes with the results of normal contralateral kidneys, and finally investigate possible parameters that would affect renal vascular resistance changes. Material and Methods We prospectively studied 47 patients who underwent rigid URS. Preoperative grayscale and Doppler ultrasonography (CDUS) measurements were obtained 24 h before URS. Similarly, postoperative CDUS measurements were done 24 h after the operation. The degree of hydronephrosis and location of stones in the obstructed kidneys, diameters of both kidneys, and thickness of renal parenchyma were evaluated with gray-scale US followed by CDUS with calculation of the intrarenal RI, PI, PSV, and EDV values for each kidney. Results For the operated kidneys, statistically significant P values were noticed when RI and PI values were considered (P < 0.001). ΔRI and ΔPI of the operated kidneys were also significantly greater than the values for non-operated kidneys (P < 0.001).However, it was not the case for ΔPSV and ΔEDV values. In Spearman correlation coefficient analysis, ΔRI was found to be correlated with the parameters: “operative time” and “irrigation fluid volume”. No significant relation was documented between ΔRI and the other parameters: age, gender, side of ureteroscopy, stone location, and degree of hydronephrosis. Conclusion Significant changes in RI and PI values in patients treated with URS reveal that URS can cause a significant increase in renal vascular resistance. With the increase in operative time and irrigation fluid volume used during the operation, RI seems to be significantly increased.

Diagnostic values of detrusor wall thickness, postvoid residual urine, and prostate volume to evaluate lower urinary tract symptoms in men.

PURPOSE This prospective, controlled clinical study aimed to assess the diagnostic values of detrusor wall thickness (DWT), postvoid residual urine volume (PVR), and prostate volume in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS During an 18-month period, a total of 243 males were included in the study. Three groups were assessed due to their International Prostate Symptom Score (IPSS): men with normal lower urinary tracts (n = 51; control group), men with mild LUTS (n = 60; Group 1), and men with moderate to severe LUTS (n = 132; Group 2). DWT, bladder, and prostate volumes and PVR were measured by suprapubic ultrasonography. DWT was measured when the bladder was full (DWT-1) and when it was empty (DWT-2). RESULTS The mean age for the study population was 60.0 ± 0.6 years, while the mean IPSS for the whole group was 8.0 ± 0.4. Both the bladder and prostate volumes in Group 2 were statistically significantly higher than the control group and Group 1. The mean DWT-1 values were significantly lower in the control group when compared to Groups 1 and 2. However, when study groups were compared with each other, no statistical significance was noticed (1.12 vs. 1.17 mm). In contrast, the mean PVR and DWT-2 values were significantly different in each group. There was a significant correlation between IPSS questionnaire results and all individual parameters. CONCLUSION Suprapubic transabdominal ultrasonographic assessment of the lower urinary tract in a noninvasive manner allows the clinician to assess LUTS severity in men without morbidity. Additional studies are necessary to provide further conclusions regarding this clinical procedure.

Can Hounsfield unit values of the cortex and papillae determined by computed tomography demonstrate the possibility of kidney stone formation

PURPOSE This study is aimed at measuring HU values of the renal cortex and papillae in patients with nephrolithiasis and demonstrating renal changes associated with nephrolithiasis. MATERIALS AND METHODS Measurements were performed with regard to HU values of the cortex and papillae of 82 patients with unilateral nephrolithiasis and 81 patients in the control group at the level of the upper pole, middle region and lower pole of both kidneys. RESULTS When the HU values obtained from the upper pole, middle region and lower pole of the kidney with calculi and unaffected kidney in patients with nephrolithiasis were compared with those for the control group, the difference among the groups were found to be significant (p<0.001). A comparison of the cortex and papillae densities of the affected and unaffected kidneys in patients with unilateral nephrolithiasis were compared with regard to the upper pole and middle region, no statistically significant difference was observed with regard to both the cortex and papillae densities of the upper pole, middle region. However, in those patients with calculi in the lower pole, the region with calculi has a higher papillae density as compared to the unaffected region. CONCLUSION Both kidneys in patients with calculi have a comparatively high renal cortex and papillae densities. In the future, this information may be useful in predicting which patients may develop nephrolithiasis.

The investigation of correlation between semen analysis parameters and intraparenchymal testicular spectral Doppler indices in patients with clinical varicocele.

Objectives Our aim was to evaluate the effect of clinical varicocele on testicular microcirculation measured by spectral Doppler analysis and investigate the correlation between Doppler ultrasonographic findings and semen parameters. Methods Fifty patients who received a diagnosis of clinical varicocele in the Urology Department of our university hospital were enrolled in this prospective study. Varicocele grades were determined according to sonographic parameters, and a scrotal vein with a diameter of 2.5 mm or greater on color Doppler ultrasonography was included in the study. Spectral Doppler measurements of testicular arteries (peak systolic [PSV]/end-diastolic velocity [EDV], resistivity index [RI], pulsatility index [PI]) were measured from capsular and intratesticular branches of testicular arteries. All the patients were also assessed by semen analysis. Results Mean age was 29.08 ± 5.42 years (range, 18–45 years). Among the whole study population, 22 men had isolated left varicocele, and 28 had bilateral varicoceles. No statistically significant correlation was found between the Doppler parameters: RI, PI, and EDV, and semen analysis parameters: count, motility, volume, and morphology. On the other hand, both in unilateral and bilateral varicocele cases, PSV was found to be significantly correlated with sperm count (P < 0.05). Conclusions Spectral Doppler analysis can provide valuable information as a noninvasive method to assess the hemodynamic changes and testicular microcirculation status in cases of clinical varicocele. However, RI, PI, and EDV values of capsular and intraparenchymal branches of testicular arteries may not be used as indicators of semen parameter deterioration. Hopefully, PSV measurement may give more conclusive data to predict sperm count. In addition, the cutoff value for this index has to be determined for future studies.

Simple breast cysts: should we treat or not?

We read with great interest the article entitled “Effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts” by Ozgen (1), which has been recently published in Diagnostic and Interventional Radiology. However, we would like to address some limitations. First, simple breast cysts do not need any follow-up, as they do not show malignant transformation. Therefore, they do not require any treatment, particularly in asymptomatic patients (2). In this study, minimum lesion volume was reported as 4 mL. Such a small lesion probably does not cause complaint in the patient. Secondly, in cases treated for pain relief, it would be interesting to see how much benefit was obtained, whether the symptoms improved after the treatment, and which symptoms were resolved after the ethanol injection treatment. Thirdly, in this article, the intervention was performed on three asymptomatic patients. The reason for ethanol injection treatment in these patients remains to be elucidated. Furthermore, after the ethanol injection treatment, ultrasonography was performed at one week, one month, three months, and six months for all patients and at 12 months, 18 months, and 24 months for all available patients. However, the follow-up of patients with simple breast cysts with repeated ultrasonography is not a cost-effective management modality, and not acceptable. Although ethanol injection might be used as an alternative for the treatment of recurrent breast cysts (3), selection of patients and duration and frequency of follow-up should be arranged meticulously.

The evaluation of renal cortical density in urinary stone disease by unenhanced helical computed tomography.

I read the article by Dr Chou and associates [1] with interest. They evaluated the secondary signs associated with ureteral obstruction from calcium and uric acid stones. They used unenhanced helical computed tomography (UCT) in order to assess the kidneys in those patients, and observed that UCT reliably showed secondary changes (such as rim sign, hydroureter, perirenal stranding, renal density) on kidneys caused by ureteral stones. Specifically, we were interested in Hounsfield unit (HU) values of the renal cortex and papilla in patients with nephrolithiasis and investigated renal changes associated with nephrolithiasis [2]. In contrast to the study of Chou et al. [1], we preferred to investigate cases with unilateral nephrolithiasis and excluded patients with ureteral stones. In addition, we formed an age-matched control group. Eventually, we observed that kidneys with calculi had significantly higher renal cortex and papilla densities when compared to the control group. Dr Chou and colleagues [1] similarly measured renal parenchymal densities from the upper, middle, and lower portions of each kidney. However, they focused on the differences in renal densities between the right and left kidneys. They revealed that nearly more than half of the patients with ureteral stones (50e73.7%) had kidneys with increased densities on the affected side. We think that both studies actually highlight similar data. Calculi in the urinary system (either in the kidney or the ureter), cause a change in renal parenchymal density. This increase starts during the acute phase in urinary stone disease and persists during the chronic phase of the disease process. As the authors already suggested in the paper, this HU increase could be a very valuable secondary sign to the clinician to predict the obstruction that had been created by the calculi during the early phase of the disease. In our study, no differences between the affected and non-affected sides within the stone-bearing group were observed. This reveals that urinary stone disease can be considered a systemic